What you can expect

During the procedure

Heart transplant surgery is an open-heart procedure that takes several hours. If you've had previous heart surgeries, the surgery is more complicated and will take longer.

You'll receive medication that causes you to sleep (general anesthetic) before the procedure. Your surgeons will connect you to a heart-lung bypass machine to keep oxygen-rich blood flowing throughout your body.

Your surgeon will make an incision in your chest. Your surgeon will separate your chest bone and open your rib cage so that he or she can operate on your heart.

Your surgeon then removes the diseased heart and sews the donor heart into place. He or she then attaches the major blood vessels to the donor heart. The new heart often starts beating when blood flow is restored. Sometimes an electric shock is needed to make the donor heart beat properly.

You'll be given medication to help with pain control after the surgery. You'll also have a ventilator to help you breathe and tubes in your chest to drain fluids from around your lungs and heart. After surgery, you'll also receive fluids and medications through intravenous (IV) tubes.

After the procedure

You'll initially stay in the intensive care unit (ICU) for a few days, then be moved to a regular hospital room. You're likely to remain in the hospital for a week or two. The amount of time spent in the ICU and in the hospital varies from person to person.

After you leave the hospital, your transplant team will monitor you at your outpatient transplant center. Due to the frequency and intensity of the monitoring, many people stay close to the transplant center for the first three months. Afterward, the follow-up visits are less frequent, and it's easier to travel back and forth.

You'll also be monitored for any signs or symptoms of rejection, such as shortness of breath, fever, fatigue, not urinating as much or weight gain. It's important to let your transplant team know if you notice any signs or symptoms of rejection or infection.

To determine whether your body is rejecting the new heart, you'll have frequent heart biopsies in the first few months after heart transplantation, when rejection is most likely to occur. The frequency of necessary biopsies decreases over time.

During a heart biopsy, a doctor inserts a tube into a vein in your neck or groin and directs it to your heart. The doctor runs a biopsy device through the tube to remove a tiny sample of heart tissue, which is examined in a lab.

You'll need to make several long-term adjustments after you have had your heart transplant. These include:

• Taking immunosuppressants. These medications decrease the activity of your immune system to prevent it from attacking your donated heart. You'll take some of these medications for the rest of your life.

  Because immunosuppressants render your body more vulnerable to infection, your doctor might also prescribe antibacterial, antiviral and antifungal medications. Some drugs could worsen — or raise your risk of developing — conditions such as high blood pressure, high cholesterol, cancer or diabetes.

  Over time, as the risk of rejection decreases, the doses and number of anti-rejection drugs can be reduced.

• Managing medications, therapies and a lifelong care plan. After a heart transplant, taking all your medications as your doctor instructs and following a lifelong care plan are vital.

  Your doctor might give you instructions regarding your lifestyle, such as wearing sunscreen, not using tobacco products, exercising, eating a healthy diet and being careful to lower your risk of infection.

  Follow all of your doctor's instructions, see your doctor regularly for follow-up appointments, and let your doctor know if you have signs or symptoms of complications.

  It's a good idea to set up a daily routine for taking your medications so that you don't forget. Keep a list of all your medications with you at all times in case you need emergency medical attention, and tell all your doctors what you take each time you're prescribed a new medicine.

• Cardiac rehabilitation. These programs incorporate exercise and education to help you improve your health and recover after a heart transplant. Cardiac rehabilitation, which you might start before you're released from the hospital, can help you regain your strength and improve your quality of life.